Healthcare Provider Details

I. General information

NPI: 1578655254
Provider Name (Legal Business Name): JENNIFER MARY BACH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 WESTPORT AVE
NORWALK CT
06851-4310
US

IV. Provider business mailing address

255 WESTPORT AVE
NORWALK CT
06851-4310
US

V. Phone/Fax

Practice location:
  • Phone: 203-349-2950
  • Fax: 203-616-4124
Mailing address:
  • Phone: 203-349-2950
  • Fax: 203-616-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number592
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number632
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: